mendiusMemberMay 4, 2013 at 1:18 pmPost count: 2
Dear dr. Corenman,
I am writing you from Italy, I am a 33-year-old gentleman. In September 2002 I had an “hit and run” accident during which I experienced the fracture of L1-L2, with loss of consciousness for about 15 minutes. When I became conscious again, I immediately started to feel a very severe pain between L6-S1 (I have 6 lumbar vertebrae), exactly at the center of the spine in mid location. This pain never stopped since then and has made my life a REAL hell.
The worst problem is that diagnostics could never explain this pain. Neither X-rays or magnetic resonance or CAT could find anything anomalous or able to justify the bad pain I continue to have. Despite this, pain never reduced in these last 11 years. I had several surgeries that didn’t meet expectations, some of them even worsened my previous condition.
SURGERIES THAT DIDN’T GIVE ANY RESULT: 2004-2005,“Denervation” of the “articular faces” of the spine (L5-L6-S1) with radio frequency. This surgery was repeated twice and didn’t cause any effect. In may 2011 I tried the “pacemaker against pain” but it doesn’t improve my condition, so it was removed.
In march 2013 I had a fusion of L6-S1, but the pain is still the same, located just under the fusion.
SURGERIES THAT WORSENED THE SITUATION: Positioning of a DIAM between L5-L6. This intervertebral shock absorber was placed about 9 years ago, with the aim of reducing the pressure on the lower part of the spine. In reality, it was not just unable to diminish the symptoms but pain moved down towards inferior limbs and the disk L5-L6 has undergone a continuous deterioration even reaching a contact with the spinal cord. In July 2010 the diam was removed, and the pain on my legs goes better.
SURGERIES THAT MODIFIED THE PAIN ZONE: In December 2009, “Denervation” of the interspinal ligament of L6-S1 with radiofrequency before and a following surgery of resection of the same interspinal ligament have brought some very small improvements. Also I had an ablation of L6-S1 spinal process. The pain has slightly moved down, both in intensity and in location, but still remaining at the center of the spine. With the denervation with radiofrequency it moved downwards of about 2 centimeters, still remaining between L6-S1 but now much closer to S1. With the following surgery, when the interspinal ligament was removed, pain has slided down in intensity as well as in localization.
Right now the pain continues to be very bad. I can stand upright only for a minute. Pain is not radiating, it is more like a stab. I have tried every kind of therapy, really everything. I had manies check, but receiving always the same answers, that is “diagnostics” is not showing anything special to justify this continuous pain and that I cannot do anything about this and I have to live like this. I must take drugs just to stay at home. I can’t go out because the pain is too much strong.
I am aware that you are used to hopeless situations but I am really desperate. The pain is just unbearable. I am not living … It is like being trapped inside my own body. It is a nightmare I have been living through since 11 years and I would like to wake up. Please, please help me, I am imploring you.
A.P.Donald Corenman, MD, DCModeratorMay 4, 2013 at 8:03 pmPost count: 8614
You must go back to the beginning to start to figure out where the pain could originate. I understand you have had multiple failed procedures. The question is still where the origin of your pain generator or generators are.
Has anyone looked at the fracture of L1-2 (or T12-L1 if you have six true lumbar vertebra) for pain generation? Nerve root injury at this level can radiate pain down into the lower lumbar spine. What type of fracture was in the L1-2 area? Was it a simple compression fracture, a burst fracture, a flexion-distraction fracture, a fracture subluxation or dislocation?
Has anyone performed diagnostic blocks (see ESI/SNRB and pain diary on this website) to determine any potential pain structures? Did you have discograms performed (see website)?
If I understand you correctly, you had a spinal cord stimulator placed that was unsuccessful. Where was it placed and why did it not work?
You had a shock absorption spacer placed above the level of your fusion at L6-S1. What does your MRI look like now? Is there degeneration of this level after that spacer was placed?PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.mendiusMemberMay 9, 2013 at 12:42 amPost count: 2
The fractures at L1-L2 are simple compression. No discogram was performed. Diagnostic Blocks works only for 5-6 hours, just for the effect of the local anaesthesia. The doctor said that the spinal cord stimulator doesn’t work because the scars are too big and the electrical impulse can’t go across the scars. at the L5-L6 level there is a little bulging.
A.P.Donald Corenman, MD, DCModeratorMay 10, 2013 at 8:50 pmPost count: 8614
Simple compression fractures can still result in a significant kyphosis (an abnormal structural bending forward of the spine) which can result in significant problems at this level as well as problems above and below. What is the measured kyphosis at the fracture levels?
Diagnostic blocks that temporarily eliminate the pain are great tools to map out the pain generators (see pain diary on the website). If you had good temporary relief, where were the blocks performed and what type of blocks were they (facet blocks, epidurals, SNRBs)?
Dr. CorenmanPLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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